The National Health Service (General Medical and Pharmaceutical Services) (Scotland) Amendment (No.2) Regulations 1989

Explanatory Note

(This note is not part of the Regulations)

These Regulations further amend the National Health Service (General Medical and Pharmaceutical Services) (Scotland) Regulations 1974 (“the principal Regulations”) which regulate the terms on which general medical and pharmaceutical services are provided under the National Health Service (Scotland) Act 1978 (“the 1978 Act”).

Regulations 3 and 4 of the principal Regulations is amended to include child health surveillance services (set out in a new Part 1A of Schedule I to the principal Regulations) and minor surgery services (set out in a new Part 1B) among the services provided by medical practitioners (“doctors”) in pursuance of arrangements made by a Health Board (“the Board”) (regulations 3 and 4), and new regulation 4A is inserted to make provision for each Board to compile and maintain lists of the doctors providing child health surveillance services and minor surgery services in its locality (regulation 5). New Parts IV and V are inserted into Schedule 1 to the principal Regulations (by Schedule 3 to these Regulations) to specify the information to be provided by a doctor applying for the inclusion of his name in, respectively, the child health surveillance list or the minor surgery list.

Amendments are made to require a Board to record additional information on the list (“the medical list”) it maintains of the names of doctors providing general medical services (regulations 4 and 5). A new regulation 4C is inserted in the principal Regulations to require each Board to compile and maintain a Local Directory of Family Doctors (“the Local Directory”) in relation to those doctors whose names are included in its medical list, and to oblige doctors to supply certain information to the Board for the purpose of the Local Directory. A new regulation 5A is also inserted to make provision for the removal of a doctor’s name from any medical list when attains the age of 70 (regulation 6). The form to be used by doctors when applying to have their names included in a medical list is replaced by a specified list of particulars and undertakings to be included in an application (Schedule 2 to these Regulations).

Regulation 8 amends regulation 15 of the principal Regulations to make provision for a patient’s application to a doctor for the provision of child health surveillance services or minor surgery services and consequential amendments are made to govern the provision of such services, in circumstances where, respectively, a patient is assigned by a Board to a doctor’s list or where a doctor is providing temporary medical services to a patient (regulations 8 and 10). Regulations 9 and 11 of these Regulations simplify the procedure whereby a patient may change the doctor who is providing, respectively, any general medical services or only maternity medical services. Regulation 12 of these Regulations amends the provision for the remuneration of doctors providing general medical services, and amendments made by regulation 13 provide for the publication by a Board of its Local Directory and of doctors' practice leaflets. Regulation 14 inserts a new regulation 33A in the principal Regulations to provide for the issue by Health Boards of guidance to assist doctors in assessing the competence of actual or prospective employees. Transitional provision is made (in regulation 17) in respect of any doctor whose claim for fees or allowances earned before the date from which the amendments relating to doctor’s remuneration come into force is not determined until after that date and in respect of any doctor whose appeal against a decision of a Board under new paragraph 13A of Part I of Schedule I to the principal Regulations (availability to patients) is not determined by 1st April 1990.

Schedule 1 to these Regulations amends Part I of Schedule 1 to the principal Regulations which contains the “terms of service” under which doctors provide general medical services to their patients. A new paragraph 3A is inserted into those terms of service to make provision for the standard of skill, knowledge and care to be expected from doctors providing child health surveillance services and minor surgery services, and an amendment is made to the definition of a doctor’s patients in paragraph 4 to include those persons to whom he provides such services. New paragraphs 6A, 6B, 6C, 6D, and 6E of the terms of service and new Parts IA and IB of Schedule 1 to the principal Regulations are inserted to make detailed provision for the nature and application of child health surveillance services and minor surgery services.

Paragraph 9 (service to patients) is amended to specify the nature of the services to be provided by a doctor, including the giving of general advice in relation to the health of his patients and the provision of consultations, vaccinations and referrals. A new paragraph 9A is inserted to oblige a doctor to produce annually, and to make available to the Board, to his patients and to certain other persons, a practice leaflet which must include certain information (specified in a new Part IC of Schedule 1 to the principal Regulations) about the personal medical services he provides.

New paragraphs 10A, 10B and 10C of the terms of service are inserted to provide that a doctor is, in addition to his general obligations, required to offer a consultation to newly registered patients (new paragraph 10A), to patients whom he has not seen within the preceding 3 years (new paragraph 10B) and to patients who have attained the age of 75 (new paragraph 10C).

An amendment is made also in paragraph 10 in connection with the employment of assistants and deputies by doctors when providing child health surveillance services or minor surgery services.

Paragraph 11 of the terms of service is amended to provide that a doctor is at all times responsible for the provision of general medical services to his patients, while enabling those doctors who have before 1st April 1990 been relieved by the Board of such responsibility at certain times to continue to enjoy such relief after that date.

A new paragraph 12A is inserted in the terms of service to require a doctor to satisfy himself as to the suitability and competence of prospective employees, having regard in particular to any guidance to doctors by the Board under the new regulation 33A in the principal Regulations (inserted by regulation 14) Paragraph 13 is amended to require a doctor to notify the Board of any change in his place of residence.

A new paragraph 13A is inserted in the terms of service to require a doctor to obtain the approval of the Board for the times and places at which he proposes to be available for consultation by his patients, and new paragraphs 13B, 13C, 13D and 13E are also inserted to make provision for the circumstances in which, and the extent to which, a Board may approve a proposal by a doctor to be available for fewer hours, or on fewer days, in each week than are specified in the new paragraph 13A. A new Part ID is inserted in Schedule 1 to the principal Regulations to specify the information to be included in applications by doctors for the purposes of paragraph 13A.

New paragraph 19A obliges a doctor to provide annually to the Board a report which must include certain information (specified in a new Part IE of Schedule 1 to the principal Regulations) about his practice and paragraph 20 is amended to enable an ophthalmic doctor to demand or accept a fee or remuneration for testing the sight of a patient.

These Regulations also effect consequential amendments in the principal Regulations arising out of and in connection with the changes mentioned above.

The Regulations come into effect, in terms of regulation 2(2), for certain purposes on 22nd November 1989, for certain other purposes on 1st January 1990, and for all remaining purposes on 1st April 1990.